TABLE 21 Expenditures for Medical Care as Percent of Total Expenditures for Current Consumption, by Family Size and Income Class, United States, 1960-1961 . (percent) Family Size Income Class 3 Persons 4 Persons 5 Persons 6 or More $ 1,000- 1,999 7.4 9.3 6.9 4.9 2,000- 2,999 7.6 6.0 4.5 4.5 3,000- 3,999 7.1 7.9 5.7 5.0 4,000- 4,999 6.8 6.2 5.6 5.5 5,000- 5,999 6.6 6.6 6.4 5.9 6,000- 7,499 6.6 6.4 6.1 5.8 7,500- 9,999 6.3 6.4 6.1 6.1 10,000-14,999 6.3 5.7 6.8 6.3 15,000 6.9 6.2 5.8 4.4 Average 6.6 6.4 6.1 5.8 Source: BLS Report No. 237-93, Part 2, Tables 1 ID, E, F & G, 1966 (69). studies that have examined this relationship. In their classic study, A Thousand Families in Newcastle upon Tyne (73), Spence and his associates found a statistically significant correlation between "consistently unsatisfactory" maternal care and number of children, although they recognized that other social factors, as well as inadequate housing and overcrowding, were involved. The matter was examined in more detail in the National Survey of Health and Development, mentioned earlier, and reported in Children Under Five (33). Like the authors of the Newcastle study, they experienced difficulty in trying to eliminate subjective judgments from the scoring for quality of maternal care. The differences they observed, however, left them in little doubt that the number of children constitutes a significant factor. They found that the "... efficiency of the mother is closely related to the size of her family in each social group, though the relationship is closest in the manual workers' families." Their data for this group are presented in Table 22. In their subsequent evaluation of the growth of the study children, they made several interesting observations about interrelations between nutrition and maternal care: The two groups where maternal care appeared to have no effect on growth were at either end of the social scale, i.e., the professional and salaried and the semiskilled and unskilled manual workers. It is possible that when a certain level of material prosperity is reached in the family the nutrition of the child is likely to be adequate whatever the capacity of the mother. Below a certain level, on the other hand, even the best managerpears, then, that larger families may be depriving themselves of medical care in order to meet other needs. No data are available to indicate whether the amount of free medical care received by low income families would alter this picture. However, free medical programs would not have any appreciable effect on families with incomes higher than $3,000 or $4,000 per year.